Implementing Preoperative Bathing Protocols in the Emergency Room: A Quality Improvement Initiative for Adult Hip Fracture Patients

Background: Hip fractures are common among adults aged 65 and older, accounting for 90% of hip fracture patients. Surgical site infections (SSIs) following hip fracture surgeries are severe complications that increase morbidity, mortality, and healthcare costs. Preoperative bathing reduces the risk of surgical site infection after hip fracture surgery by decontaminating the skin flora, such as _Staphylococcus aureus_. Local Problem: At an urban Level II trauma center, adult hip fracture patients frequently bypass inpatient units or the preoperative unit and proceed directly to the operating room. It results in surgical patients not receiving optimal preoperative care, including preoperative bathing. Methods: A standardized, evidence-based preoperative bathing protocols and educational intervention were implemented in a Level II trauma center Emergency Department to enhance preoperative bathing compliance among adult hip fracture patients. Nursing knowledge retention of the evidence-based protocols was evaluated through pre- and post-education tests, and the compliance rate was measured via EHR audits. Results: A total of 142 ED staff members completed the online education modules. Pre- and post-test results showed improved knowledge across all five questions, with the most improvements in evidence-based preoperative bathing protocols (55.2% to 89.9%) and process-specific knowledge (37.8% to 83.8%). Compliance increased from 58.0% pre-intervention to 69.9% post-intervention, with a peak monthly compliance of 88.9% at the end of the intervention month (August). ED nurses expressed positive attitudes toward the initiative and understood the importance of preoperative bathing to reduce the risk of SSIs. Conclusions: Integrating preoperative bathing protocols for adult hip fracture patients within ED workflows improved compliance and knowledge. It highlighted the ED’s vital role in continuing SSI prevention and promoted interdepartmental collaboration between the emergency department and perioperative services. This quality improvement project laid the foundation for creating a standardized preoperative care order set on EHR, which enhances sustainability and improves surgical patient safety throughout the care continuum.